Reduction In Mean Number Research Articles

An examination of depression severity and treatment adherence among racially and ethnically minoritized, low-income individuals during the COVID-19 transition to telehealth

Mental healthcare was fundamentally altered during the COVID-19 pandemic, perhaps most prominently through the massive shift towards telehealth. Herein, we evaluated effects of the transition to teletherapy on treatment adherence and depressive symptoms for 3,476 patients at three outpatient psychiatric clinics, the majority of whom were low-income and experienced ethnoracial minoritization. Number of missed appointments decreased (mean: 6.27 vs. 3.77, p < .0001), and PHQ-9 scores decreased (mean: 8.17 vs. 6.82, p < .0001) between six months prior to and following the March 18, 2020 switch to telehealth. These conclusions held when adjusting for covariates including age, sex, race/ethnicity, and insurance status (i.e., socioeconomic status). Stratified analyses (i.e., adults, emerging adults, and youth) yielded the same conclusions, with the exception of emerging adults, for whom the PHQ-9 change was not significant. Results indicated the transition from in-person to teletherapy was associated with significantly reduced mean numbers of missed visits and depressive symptoms. Such results during this especially tumultuous period may underscore telehealth's effectiveness. Future research should explore whether there is a causal relationship between telehealth or mixed hybrid options, positive treatment outcomes, and prescriptive care delivery models, as well as applications of e-mental health tools for diverse, underserved patient populations.

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

Untreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive. To test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs). The Pediatric Providers Against Cavities in Children's Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3). Clinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory-based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone. Dental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data. Eighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = -0.27; 95% CI, -0.56 to 0.02). In this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs. ClinicalTrials.gov Identifier: NCT03385629.

Macrophages modulate mesenchymal stem cell function via tumor necrosis factor alpha in tooth extraction model.

Mesenchymal stem cells (MSCs) and macrophages collaboratively contribute to bone regeneration after injury. However, detailed mechanisms underlying the interaction between MSCs and inflammatory macrophages (M1) remain unclear. A macrophage-depleted tooth extraction model was generated in 5-wk-old female C57BL/6J mice using clodronate liposome (12.5mg/kg/mouse, intraperitoneally) or saline injection (control) before maxillary first molar extraction. Mice were sacrificed on days 1, 3, 5, 7, and 10 after tooth extraction (n = 4). Regenerated bone volume evaluation of tooth extraction socket (TES) and histochemical analysis of CD80+M1, CD206+M2 (anti-inflammatory macrophages), PDGFRα+MSC, and TNF-α+ cells were performed. In vitro, isolated MSCs with or without TNF-α stimulation (10ng/mL, 24h, n = 3) were bulk RNA-sequenced (RNA-Seq) to identify TNF-α stimulation-specific MSC transcriptomes. Day 7 micro-CT and HE staining revealed significantly lower mean bone volume (clodronate vs control: 0.01mm3 vs 0.02mm3, p<.0001) and mean percentage of regenerated bone area per total TES in clodronate group (41.97% vs 54.03%, p<.0001). Clodronate group showed significant reduction in mean number of CD80+, TNF-α+, PDGFRα+, and CD80+TNF-α+ cells on day 5 (306.5 vs 558.8, p<.0001; 280.5 vs 543.8, p<.0001; 365.0 vs 633.0, p<.0001, 29.0 vs 42.5, p<.0001), while these cells recovered significantly on day 7 (493.3 vs 396.0, p=.0004; 479.3 vs 384.5, p=.0008; 593.0 vs 473.0, p=.0010, 41.0 vs 32.5, p=.0003). RNA-Seq analysis showed that 15 genes (|log2FC| > 5.0, log2TPM > 5) after TNF-α stimulation were candidates for regulating MSC's immunomodulatory capacity. In vivo, Clec4e and Gbp6 are involved in inflammation and bone formation. Clec4e, Gbp6, and Cxcl10 knockdown increased osteogenic differentiation of MSCs in vitro. Temporal reduction followed by apparent recovery of TNF-α-producing M1 macrophages and MSCs after temporal macrophage depletion suggests that TNF-α activated MSCs during TES healing. In vitro mimicking the effect of TNF-α on MSCs indicated that there are 15 candidate MSC genes for regulation of immunomodulatory capacity.

Percutaneous stellate ganglion blockade as an add-on therapy for the treatment of arrhythmic storm

Abstract Introduction Arrhythmic storm (AS) due to repetitive ventricular arrhythmias (VA) is a life-threatening condition that can be resistant to antiarrhythmic therapy. Sympathetic nervous system plays an important role in triggering and maintaining VA. Reducing sympathetic activity by percutaneous stellate ganglion blockade (SBG) may improve outcomes in treating AS. Purpose To evaluate the effect of SBG on outcomes of AS. Methods In this retrospective study, we analyzed 18 patients treated with SBG for AS from August 2017 to May 2022. All patient experienced VA while on antiarrhythmic drug therapy. SBG was performed under ultrasound guidance to avoid vascular structures. Either 0.75% levobupivacaine or 0.5% ropivacaine were applied to block the stellate ganglion after negative aspiration. The decision to perform unilateral or bilateral SBG was left to the operator. Results The majority of patients were male (17/18, 94.4%), mean age was 61.8 ± 13.4 years, mean BMI 28.1 ± 5.39 kg/m2, mean LVEF was 34.4 ± 12.2%, majority had an ischemic cardiomyopathy (12/18, 66.7%). Half of the patients had monomorphic VA (9/18, 50.0%), the other half had polymorphic VA (9/18, 50.0%). Majority of patients were hemodynamically unstable (13/18, 72.2%) and more than a third had a cardiac arrest (7/18, 38.9%). Half of the patients had unilateral SBG (9/18, 50.0%), and the other half bilateral SBG (9/18, 50.0%). SBG was repeated in two patients (2/18, 11.1%). On the repeat procedure, both had bilateral SBG. There were 4 minor complications (4/18, 22.2%) and no major complications. Two patients had intermittent Horner’s syndrome, one had a small hematoma on the puncture site, and one had small hematoma in the mediastinum. All complications resolved on their own and did not require an intervention. In the 72 hours after SBG, 5 patients had a recurrence of VA (5/18, 27.8%). After the discharge, 6 patients also had a recurrence of VA (6/18, 44.4%). SBG significantly reduced mean number of VA episodes in the next 72 hours (12.3 ± 11.1 vs 4.3 ± 10.6; P=0.007) with a mean difference of 8.0 VA episodes (95% CI, 4.5 - 14.0; P=0.007) (Figure 1). One patient died due to recurrent VA leading to ischemic brain damage (1/18, 5.6%). Four patients died due to non-VA related causes (4/18, 22.2%). Two deaths were due to septic shock, the other two due to cardiogenic shock. Details of baseline characteristics and outcomes are in the Figure 2. Conclusion SBG significantly reduces episodes of VA after failed antiarrhythmic drug therapy in patients presenting with AS.A before-after graph of VA after SBG.Baseline and outcomes table.

Protective and Ameliorative Effects of Adansonia digitata and Corchorus olitorius Leaves-based Diet on Gamma-irradiation induced Genotoxicity and p53 Damage in Cellular System of Rats

Exposure to gamma irradiation (γ-IR) causes cellular alterations (CA) in animals. Extract of Adansonia digitata and Corchorus olitorius leaves (ADCOL) have been shown to protect against γ-IR-induced CA in rats. Traditionally, the leaves are consumed as part of diets, however, there is paucity of scientific information on the use of ADCOL based-diet (BD) against CA. Thus, the study investigated the effects of ADCOL BD in cellular system of irradiated rats. The objectives of the study were to determine the secondary metabolites in ADCOL, induce cellular alterations in rats and evaluate the protective, ameliorative and toxicity of ADCOL BD on rats. A total of 72 rats (186 ± 4.90g) were used in the 2 phases of this study. In the ameliorative phase, 36 rats were assigned into 6 groups of 6 each; Group I were fed with rat chow and distilled water only, all other groups were irradiated, such that, Groups II III, IV, V &amp; VI were fed rat chow only, 80% inclusion of ADBD, 80% inclusion of COBD, 80% inclusion of combined ADCOLBD and Vitamin-C-BD respectively. Similar design was adopted for protective phase, except that, the rats were initially fed the inclusion diet before irradiation. Micronuclei status were viewed by automated electron microscope, p53 level was determined by enzyme linked immunosorbent assay and antioxidant status of rat were determined by standard methods. Data were analysed using Duncan multiple range test at p&lt;0.05. The findings in this study, were that; secondary metabolites constituents of A. digitata and C. olitorius were alkaloids (78.76 and 72.36g/dl) terpenoids (42.45 and 21.25 g/dl) flavonoids (13.42 and 104.81g/dl) polyphenols and (147.90 and 203.14 g/dl) respectively; γ-irradiation significantly (p&lt;0.05) increased mean number of micronuclei and decreased p53, superoxide dismutase (SOD), catalase (CAT) and glutathione (GSH) level in rats; 80% inclusion of A. digitata and C. olitorius leaf-BD significantly (p&lt;0.05) reduced mean number of micronuclei and increased p53, SOD, CAT and GSH level in irradiated rats. The study concluded, that A. digitata and C. olitorius protected cellular damage induced by radiation. Thus, recommending their use against cellular damage.

Contact and gustatory effects of Spinosad on inhibition of population build-up of Cryptolestes pusillus (Schon.) (Coleoptera: Cucujidae) after different storage periods in whea

The adult population of Cryptolestes pusillus (Schon.) was significantly (P&lt;0.001) reduced after 3-, 6- and 9-months storage periods at different concentrations of Spinosad than those of control medium. Spinosad at all concentrations reduced mean number of larval 5.33±0.72 to 52.00±0.94, 5.67±1.36 to 32.00±1.41 and 2.67±0.54 to 54.33±0.72 after 3, pupal 3.33±1.09 to 26.00±0.94, 3.33±0.72 to 26.00±1.25 and 2.33±0.29 to 16.33±0.27 after 6 and adult 5.33±1.19 to 62.00±0.47, 2.33±0.27 to 72.00±1.25 and 2.33±1.09 to 58.00±1.25 after 9 months storage period. The percent of repulsion (PRC) were always higher in higher concentrations but lower in lower concentrations in every cases. The total population of C. pusillus was 152.00±1.15 and 790.33±2.60 after 1st and 2.67±1.09 and 20.67±3.34 after 2nd generations. Spinosad effectively reduced the survivability and population of C. pusillus of the treated wheat.

Implementation of the appointment-based model in community pharmacies: An analysis of refills and adherence

BackgroundTraditionally, much of community pharmacy practice relies on patients to request their own medication refills. These refills are often not aligned, which has been shown to decrease adherence and workflow efficiencies. The appointment-based model (ABM) is designed to proactively synchronize refills and schedule patient-pharmacist appointments. ObjectivesTo describe the characteristics of patients enrolled in the ABM; and to compare the number of distinct refill dates, number of refills, and adherence for antihypertensives, oral antihyperglycemics, and statins 6-months and 12-months pre-post ABM implementation. MethodsIn September 2017, the ABM was implemented across independent community pharmacies within a pharmacy banner in Ontario, Canada. In December 2018, a convenience sample of three pharmacies was extracted. Demographic and clinical characteristics were collected on program enrollment (index) date for individual patients and their medication fill histories were used to investigate adherence measures including distinct number of refill dates, number of refills, and proportion of days covered. Descriptive statistics were analyzed using StataCorp. ResultsAnalysis of 131 patients (48.9% male; mean age 70.8 years ± 10.5 SD) filled on average 5.1 ± 2.7 medications with 73 (55.7%) experiencing polypharmacy. Patients had a significant reduction in mean number of refill dates (6.8 ± 3.8 SD six-months pre-enrollment, 4.9 ± 3.1 SD six-months post-enrollment, p < 0.0001). Adherence to chronic medications remained high (PDC ≥95%). ConclusionThe ABM was implemented for a cohort of established users, already highly adherent to their chronic medications. Results demonstrate reduced filling complexity and fewer refill dates while also sustaining the high baseline adherence across all chronic medications studied. Future studies should investigate patient perspectives and potential clinical benefits of the ABM.

Fewer glucose checks and decreased supplementation using dextrose gel for asymptomatic neonatal hypoglycemia.

Evaluate the impact of a neonatal hypoglycemia (NH) clinical pathway implementing buccal dextrose gel in late preterm and term infants. Quality improvement study at a children's hospital associated birth center. Number of blood glucose checks, use of supplemental milk, and need for IV glucose were followed for 26-months after implementation of dextrose gel and compared to previous 16-month period. After QI implementation, 2703 infants were screened for hypoglycemia. Of these, 874 (32%) received at least one dose of dextrose gel. Special cause shifts with reductions in mean number of blood glucose checks per infant (pre 6.6 vs. post 5.6), use of supplemental milk (pre 42% vs. post 30%), and need for IV glucose (pre 4.8% vs. post 3.5%) were found. Incorporating dextrose gel into a clinical pathway for NH was associated with a sustained reduction in number of interventions, use of supplemental milk and need for IV glucose.

EFFECT OF MODAFINIL ON TIME TO WEAN FROM MECHANICAL VENTILATION

SESSION TITLE: Late Breaking Posters in Critical CareSESSION TYPE: Original Investigation PostersPRESENTED ON: 10/18/2022 01:30 pm - 02:30 pmPURPOSE: Modafinil is a wake promoting agent commonly used in sleep disorders. Sedation during mechanical ventilation in the ICU disrupts circadian rhythms and results in sleep disturbances and delirium. Wakefulness and ability to follow commands is a key component of successful extubation. This study evaluates the effect of modafinil on time to wean from mechanical intubation.METHODS: This study was a retrospective study conducted at a single urban center. Chart review was performed on 511 patients. Exclusion criteria included patients who expired, were transferred to hospice for terminal extubation or those who required tracheostomy (n=256). Sub-group analysis was done on patients intubated at least 5 days prior to initiation of weaning trials (n=81). Data was analyzed with medcalc statistical software.RESULTS: Patients who were treated with Modafinil had an overall longer time to wean from the ventilator as compared to patients who were not treated with Modafinil. Further evaluation showed patients who received Modafinil were intubated at least 5 days or more prior to initiation of the weaning process. Sub-group analysis of these patients intubated at least 5 days or more showed a decrease in mean time to wean from ventilation by 1 day (4 days with Modafinil and 5 days without Modafinil) with findings not statistically significant (p=0.673).CONCLUSIONS: Although our study showed reduction in mean number of days to wean from ventilation with Modafinil, these results were not statistically significant due to reduction in the power of the study after further exclusion of patients intubated less than 5 days during sub-group analysis. Future studies should involve a higher number of patients for increased power and assess other variables such as dosage effect of Modafinil, RASS score, GCS score, presence of other sedating medications, and reason for failure of pressure support trial.CLINICAL IMPLICATIONS: This research may serve as the basis for future studies regarding the effect of Modafinil on time to wean from ventilation. Implications include potentially decreasing time to wean from the ventilator and may serve as a strategy to decrease total time of intubation in patients by promoting wakefullness and restoring circadian rhythms. Decreasing time of intubation is beneficial to shorten ICU stay and minimize risks associated with prolonged mechanical ventilation.DISCLOSURES:No relevant relationships by AdeYinka AdeniyiNo relevant relationships by Chelsae Keeney SESSION TITLE: Late Breaking Posters in Critical Care SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Modafinil is a wake promoting agent commonly used in sleep disorders. Sedation during mechanical ventilation in the ICU disrupts circadian rhythms and results in sleep disturbances and delirium. Wakefulness and ability to follow commands is a key component of successful extubation. This study evaluates the effect of modafinil on time to wean from mechanical intubation. METHODS: This study was a retrospective study conducted at a single urban center. Chart review was performed on 511 patients. Exclusion criteria included patients who expired, were transferred to hospice for terminal extubation or those who required tracheostomy (n=256). Sub-group analysis was done on patients intubated at least 5 days prior to initiation of weaning trials (n=81). Data was analyzed with medcalc statistical software. RESULTS: Patients who were treated with Modafinil had an overall longer time to wean from the ventilator as compared to patients who were not treated with Modafinil. Further evaluation showed patients who received Modafinil were intubated at least 5 days or more prior to initiation of the weaning process. Sub-group analysis of these patients intubated at least 5 days or more showed a decrease in mean time to wean from ventilation by 1 day (4 days with Modafinil and 5 days without Modafinil) with findings not statistically significant (p=0.673). CONCLUSIONS: Although our study showed reduction in mean number of days to wean from ventilation with Modafinil, these results were not statistically significant due to reduction in the power of the study after further exclusion of patients intubated less than 5 days during sub-group analysis. Future studies should involve a higher number of patients for increased power and assess other variables such as dosage effect of Modafinil, RASS score, GCS score, presence of other sedating medications, and reason for failure of pressure support trial. CLINICAL IMPLICATIONS: This research may serve as the basis for future studies regarding the effect of Modafinil on time to wean from ventilation. Implications include potentially decreasing time to wean from the ventilator and may serve as a strategy to decrease total time of intubation in patients by promoting wakefullness and restoring circadian rhythms. Decreasing time of intubation is beneficial to shorten ICU stay and minimize risks associated with prolonged mechanical ventilation. DISCLOSURES: No relevant relationships by AdeYinka Adeniyi No relevant relationships by Chelsae Keeney

Reductions in acute medication use and healthcare resource utilization in patients with chronic migraine: a secondary analysis of a phase 3, randomized, double-blind, placebo-controlled study of galcanezumab with open-label extension (REGAIN)

Aims To analyze secondary objectives of the REGAIN study related to acute headache medication use and healthcare resource utilization (HCRU) in patients with chronic migraine treated with galcanezumab, a monoclonal antibody to calcitonin gene-related peptide. Methods Adults with chronic migraine (N = 1,113) were randomized (2:1:1) and treated with double-blind monthly injections of placebo, galcanezumab-120 mg, or galcanenzumab-240 mg for 3 months, followed by a 9-month open-label extension with 120 or 240 mg/month galcanezumab. Headache and medication information was collected by daily eDiary. HCRU was reported for the 6 months before randomization, monthly thereafter, and converted to rate per 100-patient-years. Results At baseline, 63–64% of patients met criteria for acute headache medication overuse. At Month 3, incidence of headache medication overuse in the galcanezumab groups (33% and 33%) was significantly lower than in the placebo group (46%, both p < .001) and was 16% and 23% in the previous-galcanezumab groups at Month 12. From a baseline of 14.5 to 15.5, reduction in mean number of monthly migraine headache days with acute headache medication use was also significantly greater in the galcanezumab groups at Month 3 (−4.2 and −4.9) than in placebo (−2.6, both p < .001), with reductions of −6.8 and −7.6 in the previous-galcanezumab groups at Month 12. Migraine-specific HCRU rates decreased for all groups, with no significant between-group differences at Month 3. At Month 12, in the two previous-galcanezumab groups, emergency room visits decreased by 58% and 75%, hospital admissions by 100%, and healthcare professional visits by 54% and 67%. Limitations Only 3 months of double-blind, placebo-controlled data, a longer HCRU recall period for baseline than postbaseline, and patients receiving care in the clinical trial itself, may limit generalizability. Conclusions Treatment with galcanezumab resulted in significant reductions in headache medication overuse and migraine headache days requiring acute medication use, with notable reductions in migraine-specific HCRU.

Prospective 12-month outcomes of combined iStent inject implantation and phacoemulsification in Asian eyes with normal tension glaucoma

BackgroundGlaucoma is the leading cause of irreversible blindness. Normal tension glaucoma (NTG) is a subset of open-angle glaucoma, demonstrating glaucomatous optic nerve damage in the absence of raised intraocular pressure (IOP). NTG is more prevalent in Asian populations. While generally slow-progressing, NTG may be associated with significant central visual field loss. In recent years, minimally invasive glaucoma surgery has been added to the armamentarium of glaucoma surgery. This prospective study aims to evaluate 12-month surgical outcomes of combined iStent inject (Glaukos Corporation, Laguna Hills, CA) implantation and phacoemulsification in Asian eyes with NTG.MethodsThis is a prospective, single-centre case series of 30 eyes followed up until 12 months after surgery. Outcome measures included IOP, number of glaucoma medications, best-corrected visual acuity (BCVA) and intra and postoperative complications.ResultsMean age of subjects was 73.1 ± 6.3 years. Majority were ethnic Chinese (n = 27, 90%). Baseline medicated mean IOP was 13.8 ± 2.4 mmHg and mean number of glaucoma medications was 1.3 ± 0.7. Mean Humphrey visual field mean deviation was − 13.7 ± 7.6. The mean IOP reduction at all timepoints from postoperative month (POM) 3 onwards was statistically significant (all P < 0.05), with mean reduction of 1.2 mmHg (95% CI: 0.1–2.2, P = 0.037) by POM12. There was statistically significant reduction in mean number of medications from postoperative day (POD) 1 onwards (all P < 0.05), with mean decrease of 1.0 medication (95% CI: 0.9–1.1, P < 0.001) by POM12. By POM12, 25 (83.3%) eyes were medication-free. Three (10%) eyes had stent occlusion by iris requiring laser iridoplasty. One eye had gross hyphema which resolved on conservative management before POM1. Mean BCVA improved from the baseline 0.3 ± 0.3 logMAR to 0.1 ± 0.1 logMAR postoperatively (P < 0.001). There were no major adverse or sight-threatening events. No eyes required further glaucoma surgery during the 12-month follow-up period.ConclusionAsian eyes with NTG which underwent combined iStent inject implantation and phacoemulsification demonstrated a significant and sustained reduction in IOP and glaucoma medications, up to 12 months postoperatively.

P-650 Partial premature ovulation detection during follicular aspiration compromises the quantity but not the quality of the retrieved oocytes in stimulated fresh IVF cycles

Abstract Study question Is partial premature ovulation (PPO) detection during the oocyte pick-up (OPU) a sign of poor prognosis in in vitro fertilization (IVF) cycles with own oocytes? Summary answer PPO halves the number of metaphase II oocytes available for an IVF treatment without reducing their quality, demonstrated by unaltered fertilization and top-quality blastocyst rates. What is known already PPO detected during the OPU procedure has not been extensively studied in the literature. This phenomenon may result in a reduction in the number and/or competence of the oocytes retrieved, due to the potential loss of the already expelled oocytes, as well as the likely dominance exerted by the ruptured follicle/s in the rest of the cohort. Despite this, several authors have demonstrated that competent oocytes can be retrieved from these already ruptured follicles, suggesting that oocyte extrusion frequently does not occur after follicle rupture. The potential negative effect exerted in the rest of sibling oocytes remains unknown. Study design, size, duration Retrospective cohort analysis performed in IVIRMA Valencia (Spain), including 8994 cycles of controlled ovarian stimulation (COS) for an IVF treatment with fresh own oocytes, between January 2016 and May 2021. OPU procedures for oocyte cryopreservation, as well as mixed cycles with both fresh and frozen oocytes, were discarded. PPO diagnosis was based on ultrasound visualization of any already formed corpus luteum structure/s, a lower follicular count than expected, and/or free fluid. Participants/materials, setting, methods Female patients undergoing OPU after COS for a fresh IVF treatment. Cycles in which PPO has been detected will be compared with a random, and of the same size, sample without PPO. Mean number of oocytes, metaphase II, fertilized oocytes and top-quality embryos, as well as IVF success rates, will be compared between both groups. Patients’ basal characteristics and COS parameters will be analyzed in order to detect any potential early indicator of PPO. Main results and the role of chance PPO was detected in 123 of the 8994 cycles (1.37%) performed. A random control group of 123 cycles without PPO was selected. Patients’ mean age was 37.6±3.6, with a BMI of 23.3±4.1 kg/m2 and an anti-mullerian hormone of 1.62±1.3 ng/mL. Patient’s basal characteristics and COS parameters were statistically comparable among groups (p &amp;gt; 0.05), except for lower serum estradiol levels (2037.64 vs. 1582.24 pg/mL; p = 0.004) in the PPO group on the last ultrasound prior to OPU. Patients with PPO showed lower aspiration rates (88.95% vs. 55.78% in the PPO gr.), as well as a reduced mean number of oocytes (10.69 vs. 5.68 in the PPO gr.), metaphase II (8.41 vs. 4.33 in the PPO gr.), fertilized oocytes (6.23 vs. 3.26 in the PPO gr.) and top-quality blastocysts (2.77 vs. 1.35 in the PPO gr.) (p = 0.000). In contrast, maturation (80.72% vs. 76.57% in the PPO gr.), fertilization (73.52% vs. 75.18% in the PPO gr.) and top-quality blastocyst rates (44.03% vs. 38.68% in the PPO gr.) were statistically similar between both groups (p &amp;gt; 0.05). Limitations, reasons for caution The main limitations of the present study are its retrospective design and its small sample size, derived from the low frequency of the PPO phenomenon in our clinic. Larger prospective studies should be proposed in order to accurately define the negative impact of PPO in IVF success rates. Wider implications of the findings PPO clearly reduces the number of oocytes available for an IVF treatment, although it does not seem to impair the competence of the remaining cohort. Once PPO is detected, cycle cancellation may not be worth the associated loss of money, time and morale, especially given its low prevalence (around 1%). Trial registration number Not applicable

P031 Assessing the safety and efficacy of JAK inhibitors in inflammatory arthritis

Abstract Background/Aims JAK inhibitors were recently licensed in the UK and have been shown to be efficacious in refractory moderate to severe rheumatoid arthritis and psoriatic arthritis. We aim to assess their efficacy and safety in use in clinical practice in NHS Tayside. Additionally, there have been several emerging safety concerns, particularly regarding infections and venous thromboembolism risk. Methods This project was an observational retrospective case note review of 130 patients. We assessed JAK-inhibitor efficacy via mean change in DAS28 and number of tender and swollen joints at 6 months after initiating therapy. Additionally, 6-month and 2-year drug survival rates were calculated. The presence of adverse events was evaluated. Results At 6 months JAK inhibitor therapy produced a mean reduction in DAS28 of 2.04 (p = 0.096) and a mean reduction in number of swollen joints of 3.72 (p = 0.002). Drug survival was 81.42% at 6-months and 51.25% at 24-months. Non-smokers, those with BMI &amp;lt;30, biologic naïve patients and those prescribed a concomitant cDMARD all achieved a greater reduction in DAS28. 53 patients (40.77%) experienced an adverse event, including venous thromboembolism, acute diverticulitis and herpes zoster reactivation. In addition to these, 40.91% of patients experienced dyslipidaemia. Conclusion JAK-inhibitors are efficacious in controlling active disease in inflammatory arthritis, however, are better suited to some patients over others based on emergency concerns about side effect profiles. Longer follow up is needed to assess long term efficacy. Disclosure I. Smedley: None.

Seasonal Abundance of Paracoccus marginatus (Williams and Granara de Willink) (Hemiptera: Pseudococcidae) and Damage to Papaya Seedlings in Three Agroecological Zones in South-western Nigeria

The Papaya Mealybug, Paracoccus marginatus Williams and Granara de Willink, is an invasive species. The abundance of the papaya mealy bug and its damage to seedlings were investigated in the field at three agro-ecological zones: which includes Akure (Rainforest), Ogbomoso (Guinea savannah), Ibadan (Derived savannah) in the 2016 growing seasons. At each site, 10 healthy mother plants with fruit (&gt;17cm GBH) were randomly selected from which five infested and non-infested leaves (fifth to the 13th leaf from the top) were randomly selected. Number of infesting larvae were counted manually. Infestation, typified by woolly presence of the larvae on the leaves was 80.08% on the leaves and 75.58.6% on the fruits. The most susceptible papaya was recorded for Ogbomoso in March. This was done to determine the combined effects of time of the year (period) and geographical location (Agroecology) on populations and infestations of adult and immature P. marginatus on fruits and leaves of Pawpaw, and it was not significantly different (p&gt;0.05) from the other levels of infestation at the other locations in the same month of March. The highest population of P. marginatus on Pawpaw leaves (60.33) and fruits (59.83%) was recorded for Akure in March. Results showed that there was general reduction in mean number of healthy leaves of papaya seedlings as the age of the seedlings increased. It could be concluded that P. marginatus were able to establish colonies on papaya seedlings, it is only in rare cases on a few susceptible genotypes, that mealybugs colonize plants during vegetative stage

Comparison of Efficacy and Safety of XEN45 Implant Versus Trabeculectomy in Asian Eyes.

Combined phacoemulsification and trabeculectomy is able to achieve greater reduction in intraocular pressure (IOP), higher rates of complete surgical success and fewer postoperative manipulations and visits compared with combined phacoemulsification and Xen implantation in glaucomatous eyes. Our study aims to compare and understand the differences between the efficacy and safety of XEN45 implantation and trabeculectomy in Asian eyes with glaucoma. This was a retrospective, single-center, comparative study of consecutive patients who underwent combined phacoemulsification and trabeculectomy (Phaco-Trab) from January 2013 to June 2014 and combined phacoemulsification and XEN45 implantation (Phaco-Xen) from May 2017 to September 2018 in a tertiary Ophthalmology center in Singapore. Outcome measures included IOP, number of anti-glaucoma eyedrops, success rate, factors leading to success/failure, number of postoperative interventions and visits required, and surgical complications. A total of 137 eyes (91 Phaco-Trab, 46 Phaco-Xen) were included. Phaco-Trab group had greater mean IOP reduction at all time points beyond postoperative month (POM) 1 (mean difference 2.9 to 3.8 mm Hg; P<0.05), and greater reduction in mean number of antiglaucoma eyedrops beyond POM3, thought this was not statistically significant. At POM12, complete success was achieved in 83.5% in Phaco-Trab and 52.2% of Phaco-Xen group, respectively (P<0.001). There was no significant factor associated with surgical failure, other than the difference in surgical procedure. Phaco-Trab group required fewer number of postoperative interventions (P=0.009), with only a mean of 0.1 bleb interventions required per patient, versus 1.5 in Phaco-Xen group (P<0.001). Safety profiles in both groups were comparable, with no statistically significant difference in intraoperative/postoperative complications. Phaco-Trab has significantly higher reduction in both IOP and number of antiglaucoma medications compared with Phaco-Xen group, with greater surgical success and fewer postoperative manipulations and visits. Safety profiles were comparable.

Undifferentiated Dyspnea with Point-of-Care Ultrasound, Primary Emergency Physician Compared with a Dedicated Emergency Department Ultrasound Team.

Emergency physicians (EPs) perform critical actions while operating with diagnostic uncertainty. Point-of-care ultrasound (POCUS) is useful in evaluation of dyspneic patients. In prior studies, POCUS is often performed by ultrasound (US) teams without patient care responsibilities. This study evaluates the effectiveness of POCUS in narrowing diagnostic uncertainty in dyspneic patients when performed by treating EPs vs. separate US teams. This multicenter, prospective noninferiority cohort study investigated the effect of a POCUS performing team in patient encounters for dyspnea. Before-and-after surveys assessing medical decision-making were administered to attending physicians. Primary outcome was change in most likely diagnosis after POCUS. This was assessed for noninferiority between encounters where the primary or US team performed POCUS. Secondary outcomes included change in differential diagnosis, confidence in diagnosis, interventions considered, and image quality. There were 156 patient encounters analyzed. In the primary team group, most likely diagnosis changed in 40% (95% confidence interval 28-52%) of encounters vs. 32% (95% confidence interval 22-41%) in the US team group. This was noninferior using an a priori specified margin of 20% (p < .0001). Post-POCUS differential decreased by a mean 1.8 diagnoses and was equivalent within a margin of 0.5 diagnoses between performing teams (p = 0.034). Other outcomes were similar between groups. POCUS performed by primary teams was noninferior to POCUS performed by US teams for changing the most likely diagnosis, and equivalent when considering mean reduction in number of diagnoses. POCUS performed by treating EPs reduces cognitive burden in dyspneic patients.

Four-implant-supported overdenture treatment in the maxilla. Part II: Speech- and oral health-related quality of life in patients with implant-supported overdentures in the maxilla-A prospective 3-year follow-up.

Implant-supported overdentures (IOD) are becoming a more commonly used treatment in the dental practice and it risks causing speech problems. The aim of this study was investigating the changes in speech, satisfaction with speech, and overall oral health-related quality of life (OHRQoL) in edentulous patients during and after treatment with maxillary IODs. Twenty-one patients receiving an IOD participated in speech assessment. They were examined preoperatively with their conventional denture (CD) with full palatal coverage, after connection of the implant-bar connected denture, without palatal coverage, and 3 years thereafter. The examination included assessment of articulation in speech, OHRQoL based on total OHIP-14, and satisfaction with overall oral health and speech (visual analogue scale). There was a reduction in mean number of articulation disorders from 1.00 at baseline to 0.55 at connection, although statistically insignificant (p=0.059). Especially the /s/ sound is vulnerable. At 3 years follow-up, still 6/16 (37.5%) of the patients suffered from this speech problem. Overall satisfaction improved from 64.05/100 at baseline to 82.95/100 at connection (p=0.008) and remained unchanged with 81.69/100 after 3 years follow-up. Patients' satisfaction with speech increased from 70.62/100 with CD to 82.63/100, 3 years follow-up (p=0.009). Total OHIP-14 decreased from 21.45/56 with CD to 8.00/56 (p < 0.001) with IOD and 6.13/56 3 years after connection (p=0.001). Significant improvement of all seven domains in OHRQoL was observed with IOD compared to CD. Patients treated with maxillary IODs show improved OHRQoL 3 years after connection of the IOD compared to the CD. Even though patients reported improvement of satisfaction and OHRQoL, articulation disorders were still present, suggesting that patients should be informed about possible speech issues.

Early Recognition Method – Amplifying relapse management in community mental health care; a comprehensive study of the effects on relapse and readmission

This naturalistic multicenter study explored the relationship between participating in the Early Recognition Method (ERM) intervention and relapse, defined as spending at least one night at a psychiatric ward. The intervention was tailored to adult patients with schizophrenia or bipolar disorder in an outpatient mental health care setting.Before the intervention, the staff received training in application of the strategy. The ERM strategy is protocolized and includes identification and monitoring of individual early warning signs and development of a personal plan of action. The study showed a reduction in mean number and duration of readmissions during the period the patients participated in the intervention, compared to an equal pre-intervention period. For patients with bipolar disorder the reduction was statistical significant. The difference in outcome between the two diagnostic groups suggests that further tailoring of the application of the ERM strategy might improve the relapse prevention outcome.

Changes in Prescribing by Provider Type Following a State Prescription Opioid Restriction Law.

Many states have implemented opioid days' supply restriction policies, leading to reductions in opioid prescribing. Although research within certain provider types exist, no study has evaluated a restriction policy by various provider types. To evaluate changes in opioid utilization following a days' supply restriction policy stratified by provider type: surgery, emergency medicine, primary care, specialty care, and dentistry. Interrupted time series (ITS) PARTICIPANTS: Opioid prescription claims of patients in a private health plan serving a large Florida employer from 1/1/2015 to 3/31/2019. Provider types were determined using the Healthcare Provider Taxonomy Code associated with the national provider identifier (NPI). Florida's opioid restriction policy implemented on July 1, 2018. Changes in mean morphine milligram equivalent (MMEs), mean days' supply, and mean number of units dispensed per opioid prescription before and after policy implementation. There were 10,583 opioid initial prescriptions dispensed. Treating providers were classified as surgery (16.4%; n = 1732), emergency care (14.3%; n = 1516), primary care (21.2%; n = 2241), specialty care (11.4%; n = 1207), and dentistry providers (23.7%; n = 2511). Significant reductions in mean days' supply were observed across most provider types ranging from 14% reduction for dentistry providers to 41% reduction for specialty care providers. Significant changes were observed for emergency care and specialty care providers with a 30% (p = 0.001)and 29% (p < 0.001) reduction in mean MME, respectively, and a 27% (p = 0.040) reduction in mean number of units dispensed in emergency care providers, after implementation. Pre-implementation trends in opioid prescribing varied by provider type impacting the effects of the opioid days' supply restriction policy. Pre-policy opioid prescribing varied by provider type with a differential impact on mean MMEs, mean days' supply, and mean number of units dispensed per prescription following implementation.

Evaluating the effectiveness of fluoride varnish in preventing caries amongst Long‐Term Care Facility Residents

To evaluate the effectiveness of professionally applied fluoride varnish on the incidence of dental caries amongst older adults resident in LTCFs in Northern Ireland. The oral health status of older adults within Long-Term Care Facilities (LTCFs) is significantly worse than their community living peers. Whilst evidence suggests an important role for fluoride varnish in preventing caries in this population, very few studies have evaluated this intervention. A quality improvement project was undertaken with dentate residents (n=190) in nine LTCFs who had fluoride varnish applied by Dental Care Professionals on two separate occasions during a 12-month period (intervention group). Nine LTCFs were chosen as matched controls (control group) with comparable numbers of residents of similar medical status (n=217). For the intervention group, oral hygiene training was also provided for the care home staff. A total of 407 patients (n=271 female) were included in the analyses (mean age [SD]: 84.1 [6.6] years). After 12months, the intervention group recorded a significant reduction in mean number of carious teeth (mean [95% CI]: -0.85 [-1.12, -0.58]; P<.001). Patients in the control group had significant increases in the mean number of carious teeth (mean [95% CI]: 0.21 [0.05, 0.37]; P=.012), mean plaque score (mean [95% CI]: 1.16 [0.28, 2.04]; P=.010) and mean DMFT score (mean [95% CI]: 0.13 [0.04, 0.22]; P=.004). This study demonstrates the potential role of fluoride varnish in combination with oral hygiene training for staff in the prevention and arrest of carious lesions among older adults in LTCFs.